Pattern and Outcome of Iatrogenic Genitourinary Fistula from Obstetric and Gynaecological Surgeries in a Tertiary Institution, North-Western Nigeria

Introduction: Genitourinary fistula is commonly caused by prolonged obstructed labour; however, not all genitourinary fistulas are obstetric in origin. Inadvertent injuries to the urinary tract leading to fistulae do occur during obstetric and gynaecological procedures because of the close anatomical relationship between the urinary tract and the genital tract.

Objectives: This study aims to determine the prevalence, aetiology and outcome of iatrogenic genitourinary fistula repair at the National Obstetric Fistula Centre, Katsina (NOFIC).

Methodology: This was a two-year retrospective review of all patients who had surgery for iatrogenic fistula between 1st January 2015 and 31st December 2016 at NOFIC, Katsina. All patient case notes on this procedure during the stated period were retrieved and analysed.

Results: A total of 728 genitourinary fistula surgeries were carried out in the Centre, out of which 117 (16.1%) were repairs for iatrogenic fistulae, giving a prevalence rate of 16.1%. Only 110 case notes were eligible for analysis, giving a retrieval rate of 94%. The mean age of the patients was 30.40 ± 8.39 years, and the modal parity was 1. All presented with a history of continuous urine leakage, and 71 (64.5%) had a history of a previous caesarean section. The procedures that lead to the development of the fistula were conducted at secondary healthcare centres in 84 (87.5%) of the patients. The fistulae were a result of emergency caesarean sections in 73.6% of the cases, yankan gishiri in 9.1%, caesarean hysterectomies for ruptured uterus in 6.4%, elective caesarean sections in 4.5% and gynaecologic hysterectomies in 5.4%. A diagnosis of vesicocervicovaginal fistula (VCVF) was made in 62.7% of the cases, vesicouterine fistula (VUF) in 12.7% and ureteric fistula in various combinations in 10%. The abdominal route was used for the repair in 20.9% of the patients. Intraoperative bleeding was the commonest (21%) complication associated with vaginal repair of VCVF. At discharge, 73.6% were successfully closed and continent, while 19.1% had residual fistula.

Conclusion: The prevalence of 16.1% found in this study was high, and the most common cause of iatrogenic fistula was emergency caesarean sections. The majority of the causal procedures were done at secondary healthcare centres; therefore, this study recommends adequate training, mentoring and ongoing supervision of doctors conducting caesarean sections and other gynaecological procedures in secondary health centres as well as increased community education and involvement in preventing harmful traditional practices like yankan gishiri.